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Background: The lips frame the mouth and are an important facial feature. What is seen on the lips is the dry vermilion with a little wet vermilion, known as the red part of the lips. The amount of vermilion seen determines the size of the lips. The junction of the vermilion and the skin, particularly the upper lip, determines their shape.

The lips are an important gender identifying feature. (even without makeup) As a general rule, desirable lips in women are fuller and have a more defined Cupid’s bow. It is not as important in men that lips necessarily be full. And most men do not have a well defined Cupid’s bow shape. While many women do have thin lips with little shape, often with aging, youthful feminine lips are associated with significant vermilion size and shape.

While there are many facial feminization surgery procedures, lip augmentation  is often a very important one. In achieving this change, a vermilion advancement is an effective and powerful procedure to do so. Changing the position of the vermilion-cutaneous junction through skin removal allows for much increased vermilion exposure. In the process the arc of the vermilion and the strength of the Cupid’s bow portion of the upper lip can be enhanced.

Case Study: This middle-aged male to female transgender patient was to undergo a fairly complete facial feminization procedure. The lips were thin (less than 7mms of exposed vermilion) and the mouth corners were turned down

As part of an overall nine hour facial feminization surgery, upper and lower lip advancements were performed. The size of the skin removed from the upper and lower lips was 3mms. The Cupid’s bow of the upper lip was sharpened. (stronger points) The two weeks result showed how dramatic such vermilion lip advancements can be.

Lip advancements may be a small in size facial feminization surgery procedure but its effects are significant. It does create a fine line scar at the vermilion-cutaneous junction but this heals extremely well particularly in genetic male facial skin that is naturally thicker with beard hairs.


1)The size and shape of the lips is a major feminine facial feature.

2) Vermilion advancements are the most powerful lip augmentation procedure because it can change both size and shape.

3) In the transgender male to female patient changing the mouth area with a surgical lip augmentation is a small but important facial change.

Dr. Barry Eppley

Indianapolis, Indiana

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